During my traveloverseas to meet my husband’s extended family, I met with five Family Psychologists in Athens to discuss their perspective on Family dynamics and the practice of Family Psychotherapy in Greece. Lena Koutsoudi Iola, Maria Gogorosis, Eva Lychrou, Tatiana Manessi, and MarilenaKaramatsouki met with me to discuss what they find meaningful, the challenges they face, and their hopes for the future of Family Therapy in Greece.Since we met at the beginning of my visit, there were observations I made of the landscape of Greece that illustrated some of the struggles they experience in their profession. As I compare my experience in America to these observations of Greece, I wonder about the context in which Family Psychotherapy can grow in Greece and how to contribute to that growth. In addition, these providers helped me understand some of the Greek values that may have an influence in my own family.

Lena has been a family psychologist since 1993 and has seen moderate changes in her work. When she began most individuals and families in Greece did not understand the purpose of psychotherapy, and this lack of understanding continues to influence her work into 2010. Lena studied clinical psychology in Geneva, but found she needed additional training in Greece to provide an adequate understanding of family systems and how families change. Maria was born and raised in Australia but she studied and trained in Narrative Family Therapy in Greece . Eva studied initially in Greece, and continued her education in the UK to learn systemic family therapy. Marilena and Tatiana also studied initially in Greece; after their undergraduate studies, Tatiana continued her education with a M.Sc. by distance in the UK, whereas Marilena followed a M.A. in Clinical Psychology. Lena and Maria ran a kindergarten to supplement their income and access families to provide a foundation for intervention in family systems through child development practice. They have trained other practitioners, once as many as 10 trainees at a time. Eva, Tatiana and Marilena are three of the trainees who have continued to collaborate with Lena and Maria in their practice. This group has provided a foundation for a new generation of family therapists.Some of the children who were in their kindergarten have returned for psychotherapy services as they matured.

The challenges they face stem from cultural values that discourages asking for help, coupled with a social-political system that lacks coordination of care, and cultural misunderstandings about how to intervene with families effectively while preserving connections. Lack of financial support for ongoing psychotherapy from the health care system and the medical community undermines the possibility that families can access services needed to prevent or manage mental health problems. These family therapists live and work in a culture that views asking for help as an insult to parents, a betrayal of confidence, and sees separation and individuation as rejection. They often have clients who are expected to remain with their parent’s home and the only means of individuation is to marry, if then. Parents build additional levels on their homes rather than have their adult children move out on their own, and in some families the boys are not allowed to marry until the girls are married regardless of birth order. Loyalty to parents is first priority. For example, one of the psychologists would have preferred to study family therapy in Chicago, but studied inthe UK because Chicago was too far away for her family to tolerate. They find that when family therapy is offered the parents of clients are defensive and insulted by the implication that they need help. The stigma is strong, and many laymen do not understand the difference between a psychiatrist and a family counselor.

The psychotherapy profession is not as diverse in Greece and there is limited participation in the practice. The stigma described above prevents families from using the help when it is available. The University offers only general psychology and clinical psychology degrees. No counseling programs, clinical social work, or family studies programs exist in Greece. Most lay-people do not understand the difference between a psychiatrist and psychologists and they believe all psychotherapy is psychoanalysis. The practice of psychotherapy is regulated by the European Certificate of Psychotherapy adopted in 1997, originated by the European Association for Psychotherapy founded in 1991. Mental health care issues that are complicated by family issues, such as child abuse or anorexia, lack coordination of care. Referral to providers is limited due to misunderstanding from other professionals and lack of infrastructure. The health care system failsto provide any preventative care or after care when major behavioral health problems require treatment. The most these providers can expect from the health care system is short term hospitalization for major mental health crisis to stabilize the patient, who is released without follow up care; neither are provided nor recommended. Any outpatient psychotherapy service must be paid for out of pocket by the clients requesting care.

As I traveled around Athens, Santorini and Kavala, I observed a landscape colored by graffiti, overflowing trash cans, and stay animals wandering the streets. Although this was more prevalent in Athens than in the other areas, it was present in the three communities I visited. I wondered about the relationship between the strays and the infrastructure that supports the vulnerable populations in Greece. In America, the child welfare movement was an afterthought of animal welfare movement that resulted in the Animal Welfare Act of 1966. The Child Abuse and Prevention Act was passed in 1974 in America, although the Social Security act in 1930 included funding for neglected and dependent children. Comparatively, Greece signed the Convention on the Rights of the Child on January 26, 1990. In Greece, there is no centralized agency designated to provide care and assistance and to supervise the various services provided by the State. Instead, a number of government agencies are responsible for providing social welfare and health services, as well as free education and child care. Generally speaking, the Ministry of Health and Welfare is responsible for health services, and the Ministry of Social Assistance is responsible for assistance to children who are vulnerable, that is orphans, the handicapped, and trafficked children. The Ministry of Health and Welfare and the Ministry of the Interior have joint responsibility at the national level for early childhood care. Local authorities are responsible for preschools and child care services; the Ministry of Education supervises the early childhood programs at the national level. The Ministry of Labor and Social Security handles the social insurance benefits and the family allowances for each child. The Social Insurance Institute (IKA) administers benefits through local offices. These Family Psychotherapists reported that the poor coordination of care for abused and neglected children often made providers reluctant to engage these agencies to protect the children, for fear of doing more harm than good.

Despite these challenges this group of family psychologists provide services for individuals and families they have come to develop relationships with over the years. Some of the children who were once in their Kindergarten are now grown with families and have accessed their services or referred others for care. These providers continue to train and supervise new psychotherapists who want to work with family systems even when the demand for services are low, coordination of care is poor, and services are not funded by the health care system in Greece. Families outside of Athens are even more limited in terms of access due to the village mentality of the communities and even greater stigma than in the big city. These families are even more entrenched in old world values that discourage asking for help outside or even within a family.

Hope for the future of family therapy in Greece is complicated by the the current challenging economic and political climate in Greece. Since the profession is unregulated by licensing laws and lacks funding from health care insurance, all services are based on the consumers’ needs and ability to pay. Outside of improving their ability to serve the need of families, there are no continuing education requirements from the licensing boards or insurance companies. Continuing education needs are based on making family therapy interventions as effective and efficient as possible to maximize the care provided to families. Current political unrest and lack of faith in the government makes it unlikely that these providers or families could hope for the government to support their services. Great interest was expressed in a system of teaching deep empathy and expressive skills to improve connections and allow individuation within families, who practice these skills within their families and in their communities.

It is my hope that this meeting is the beginning of ongoing communication and support. Access to online services such as web based training and education increases access to training and education that would have been limited in the past by the need to travel long distances, either by the trainer or the trainee. Exposure to multiple perspectives with an emphasis on understanding the cultural implications of the Greek family systems is essential to supporting the care providers in this community. Access to an understanding of the modern Greek family in other countries can provide help to multi-cultural families. Our mutual interest in understanding and supporting Greek families within and outside of Greece are at the core of our commitment to support each other in the future.

2 Responses to “Making Relationships a Priority in Greece – One Perspective on Greek Family Psychotherapy”

Hi Lisa…I take a very different perspective from the observation of the “stray” animals that we observed in Greece. I saw this as an enlightenment on the part of the Greeks that we, in our own country, are a long way from. We leash, cage, dress in clothes and psychoanalyze our pets. The Greeks let the semi-feral cats and dogs live beside them, allow them to come and go, where they wish, on their own.

I saw in this as I observed in many other places in Greece a live and let live attitude, a seize the moment, enjoy life attitude.

I think instead of teaching Greeks, I have more than a lifetime to learn from them.

I see your point Greg, since we also euthanize our strays. If you ever saw the video of what life would be like without humans, our fostering their dependency on us will not help them if humans go extinct.